Gender and sexual minority adults in Bangladesh experience high levels of stigma-related stress. Acute stress can trigger strong, affect-driven urges to smoke, vape, or engage in stress-attributed eating. These urges can rise and fall within minutes to hours, operating outside the reach of conventional clinic-based interventions delivered days or weeks later.
This pilot micro-randomized trial (MRT) evaluates whether delivering a brief, culturally adapted support message via smartphone during moments of high self-reported stress reduces the intensity of the urge for the participant's pre-specified target behaviour, relative to no message. Over a 24-day period, 115 participants will be scheduled for up to 5 ecological momentary assessments (EMA) per day. Whenever a participant reports an acute stress level of 5 or higher (0 to 10 scale) and satisfies pre-specified privacy, safety, behavioural, and spacing criteria, the app randomizes with probability 0.5 to deliver either a brief support message or no message. By contributing multiple randomized decision points over time, each participant serves as their own micro-control.
The primary outcome is the intensity of the urge for the participant's pre-specified target behaviour, measured 45 to 60 minutes after randomization. An exploratory urge assessment is also collected 10 minutes after randomization; comparing the two time points will help establish whether the support message's effect is immediate, delayed, or both, and will inform the choice of follow-up window for a future, fully powered trial. Prior to trial launch, all EMA items, message content, notification logic, and digital safety protocols will be developed and tested with community members, reviewed by a Community Advisory Board, and locked.
As a pilot optimization trial, its objectives are to estimate the short-term causal effect of the prompt, to identify the contexts in which that effect is larger or smaller, and to establish whether momentary assessment and just-in-time intervention research can be delivered safely, privately, and acceptably in this high-stigma setting. The study does not evaluate long-term behavioural maintenance and does not claim to address the underlying structural stigma and discrimination that produce minority stress.
Inclusion Criteria:
Exclusion Criteria:
pritom.das@icddrb.org
All participants enter a single 24-day micro-randomized cohort. At each eligible high-stress decision point, the platform independently randomizes with probability 0.50 between two momentary options. Support prompt: The app immediately delivers one brief, culturally adapted coping-support message from a locked library. The message is matched to the participant's prespecified target behavior, can be read in under one minute, and does not disclose identity or community membership. No prompt: No immediate coping-support message is delivered. The 10-minute micro-check and 45-minute follow-up are delivered on the same schedule in both options. No existing care is withheld, and participants retain access to study contact and distress-referral information. The contrast is immediate support prompt versus no immediate support prompt. Thus, the estimated proximal effect combines receiving the message with its coping content; these components are not estimated separately.
Testing the Impact of Smartphone-based Messaging to Support Young Adult Smoking Cessation - Pilot
Testing the Impact of Smartphone-based Messaging to Support Young Adult Smoking Cessation
Effectiveness of Ecological Momentary Assessment Based Smoking Cessation Intervention